Seemingly valid Medicare card form (PB136)

Use this form if you are a pharmacist who have previously submitted a PBS or RPBS claim to us which has been rejected based on the patients Medicare card number.

Download and complete the Seemingly valid Medicare card form.

Complete this form for your patient if we found that the Medicare or Repatriation card details were invalid, and they have presented another script and cannot provide an alternative Medicare or Repatriation card details.

This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please contact us. We can help you access, complete and submit them.

Page last updated: 20 February 2020